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Left renal vein variations

Variations de la veine rénale gauche

  • Anatomic Variations
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Summary

The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The study aimed to identify these variations and to document its incidence. Cadaveric study: 153 kidney pairs were harvested en bloc, dissected, 100 resin casts prepared and 53 plastinated; renal venography performed on further 58 adults and 20 foetal cadavers. Clinical study: (retrospective analysis): a) radiological study, 104 renal venograms; b) live related renal transplantation, 148 donor left kidneys; c) abdominal aortic aneurysm surgery, 525 patients. Total sample size: 1008. Renal collars observed in 0.3%; retro-aortic vein 0.5%; additional veins 0.4%; posterior primary tributary 23.2%, (16.7% Type IB; 6.5% Type IIB, cadaveric series, only). Our results differ significantly in incidence to that reported in the literature: renal collar 0.2–30%; retro-aortic vein 0.8–7.1%; additional renal vein 0.8–6%. Variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy. To a transplant surgeon, morphology acquires special significance, since variations influence technical feasibility of operation. Prior knowledge of circum-aortic vein is important when blood samples from suprarenal or renal veins are collected. Collar may provide developed collateral pathway immediately after surgery if renal interruption planned without awareness of its presence. Variations restrict availability of vein for mobilisation procedures. In aortic aneurysm repair, retro-aortic vein is important. During retroperitoneal surgery, the surgeon may visualise a pre-aortic vein but be unaware of an additional retroaortic component or a posterior primary tributary, and may avulse it while mobilising the kidney or clamping the aorta.

Résumé

Du développement embryologique très complexe de la veine rénale gauche, comparé à son homologue droit, il résulte d'importantes variations, significatives du point de vue clinique. Le but de cette étude est d'identifier ces variations et de préciser leur fréquence. 1-Recherches cadavériques : (153 paires de reins ont été prélevées en bloc, disséquées) 100 moulages par résines et 53 plastinations. En outre, des phlébographies rénales post-mortem ont été réalisées, 58 chez des adultes, 20 chez des fœtus. 2-Etudes cliniques (analyse rétrospective) : a) radiologiques : 104 veinogrammes rénaux, b) lors de transplantations rénales : 148 reins gauches de donneurs, c) au cours de la chirurgie de l'anévrysme de l'aorte thoracique : 525 patients. Soit, au total, 1008 reins. Le collier rénal a été observé dans 0,3 % de la série ; la v. rétro-aortique, 0,5 %, des vv. rénales supplémentaires : 0,4 % ; enfin, un collecteur rénal postérieur existait dans 23,2 % des séries cadavériques (16,7 % du type IB de notre classification et 6,5 % du type II B). Nos résultats diffèrent de façon significative par leur faible fréquence de celle relatée dans la littérature : collier rénal (0,2–30 %), veine rétro-aortique (0,8–7,1 %), veine rénale supplémentaire (0.8–6%). Les variations sont silencieuses cliniquement et demeurent méconnues jusqu'à leur découverte par phlébographie, opération ou autopsie. Pour le chirurgien transplanteur, la morphologie a une signification particulière puisque les variations déterminent la faisabilité technique ou non de l'opération. La connaissance préalable de la veine circum-aortique est importante lors du prélèvement d'échantillons sanguins des veines surrénaliennes ou rénales. Le collier rénal peut favoriser la formation d'un réseau collatéral dense immédiatement après l'opération, si l'interruption de la veine rénale est pratiquée sans connaissance de ce dispositif. Les variations restreignent l'utilisation de la veine dans les techniques de mobilisation. Lors de la cure d'un anévrysme aortique, l'existence d'une veine rétro-aortique est importante à connaitre. Lors d'une intervention rétro-péritonéale, le chirurgien repère la veine pré-aortique, mais il méconnait une branche rétro-aortique supplémentaire, ou un tronc primaire postérieur qu'il peut léser en mobilisant le rein ou en clampant l'aorte.

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Health Sciences, University of Durban-Westville, Private Bag X54001, 4000, Durban, South Africa

    K. S. Satyapal & J. M. Kalideen

  2. Department of Surgery, Faculty of Medicine, University of Natal, P.O. Box 17039, 4013, Congella, South Africa

    K. S. Satyapal, A. A. Haffejee, B. Singh & J. V. Robbs

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  1. K. S. Satyapal
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  2. J. M. Kalideen
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Satyapal, K.S., Kalideen, J.M., Haffejee, A.A. et al. Left renal vein variations. Surg Radiol Anat 21, 77–81 (1999). https://doi.org/10.1007/BF01635058

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